Ventral hernias are the result of failed abdominal closure. Older age, obesity, pulmonary complications, abdominal distension, male gender, wound infections, type of incision and closure, and male gender have all been implicated as risk factors for incisional hernias. Incisional hernias occur in 2-10% of patients following laparotomy. Midline incisions may be at higher risk than transverse incisions for herniation. Wounds complicated by infection are 5 times as likely to be complicated by hernias. Primary incisional hernia repairs may recur in as many as 30-50% of repairs. Mesh repairs are reported to have recurrence rates of 10%. Small incisional hernias may be repaired primarily; however, mesh repairs are frequently indicated. Adequate repair can be performed open or laparoscopically. In patients who have lost the "right of abdominal domain," progressive pneumoperitoneum (sequential insufflation of air into the peritoneal cavity) may be useful.9
Umbilical hernias are usually congenital and usually close spontaneously by 2 years of age. Adult umbilical hernias are acquired. Their incidence is increased by factors that increase intra-abdominal pressure (ascites, pregnancy etc.). Repair can usually be performed primarily however mesh can be used for larger hernias.
Femoral hernias occur through the femoral canal medial to the femoral vein. These may present as a bulge below the inguinal ligament. Incarceration is common. Femoral hernias can be repaired with a McVay (Cooper's ligament) repair, preperitoneal repair, or laparoscopic repair.3
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